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A Lambiase, S Bonini, A Bruscolini, R Sgrulletta, A Di Domenicantonio, S Bonini; Montelukast is Effective in Vernal Keratoconjunctivitis (VKC): a Pilot Study . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2228.
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Purpose: Montelukast is a cysteinil-leukotrienes (LT) receptor antagonist proven effective in the treatment of asthma. VKC is an allergic conjunctivitis often associated with asthma, in which a pathophysiological role of leukotrienes has been suggested. This study evaluates the effects on signs and symptoms of a coexisting VKC in patients treated with oral montelukast for their asthma. Methods: Twelve patients (age 4-31 years; 9M and 1F) with asthma and VKC were enrolled in this open, uncontrolled study. Topical eye drops or any systemic treatment were discontinued for at least 7 days before montelukast treatment (5mg/die in children and 10 mg/die in adults). Patients were asked to record peak expiratory flow rate (PEFR) at 8AM and to grade their ocular discomfort daily. The following signs and symptoms were also recorded and graded through medical examination at baseline, after 15 days of treatment and 15 days following treatment discontinuation: tarsal and bulbar papillae, hyperemia, secretion, chemosis, itching burning, tearing, photophobia, foreign body sensation, secretion, and redness. Samples were collected at the same time points for ELISA measurement of LTB4 (tears) and E4 (urine). Results: Ten patients completed the study. All patients showed an increase of PEFR (-9.6±16.6% of predicted value vs. 21.9±21.1% at baseline) and reported a significant subjective reduction of symptoms the end of treatment. Montelukast treatment significantly improved (hyperemia, secretion and chemosis) 3 of the 5 signs and 5 (burning, tearing, photophobia, secretion and redness) of the 7 symptoms considered. Total signs score decreased from 7.8 ± 2.1 at baseline to 3.5 ± 2.1 after 15 days of treatment (p=0.0017), total symptoms score from 13.5 ± 2.1 to 5.0 ± 3.0 (p=0.0005). Effects persisted 15 days after discontinuation of treatment (total signs score = 5.0 ± 1.7; p=0.0251; total symptoms score = 7.5 ± 4.5; p=0.0071). Clinical changes were associated with a significant increase of LTB4 in tears and a significant decrease of LTE4 in urine after 15 days of treatment. Mild side effects were reported by 3 patients (transient skin itching during the first days of teatment). Conclusion: In this open uncontrolled study a systemic 15 days treatment with montelukast, induced a significant and persistent reduction of ocular signs and symptoms in asthmatic patients with VKC.
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